Emergency Medicine Journal最新文献

{"title":"Practitioner experiences of developing and implementing two UK ED-based hospital violence intervention programmes: a process evaluation.","authors":"Simon Moore, Jordan Van Godwin, Graham Moore, Megan Hamilton, David O'Reilly","doi":"10.1136/emermed-2024-214333","DOIUrl":"10.1136/emermed-2024-214333","url":null,"abstract":"<p><strong>Background: </strong>EDs can address modifiable risks of patients attending due to violence. Hospital-based violence intervention programmes (HVIPs) can reduce patients' exposure to violence but can place additional burdens on staff. We explored practitioners' views on two nurse-led HVIPs' design and delivery, response to patient need, engagement with ED health professionals, adaptation to local context and analysed documents relevant to these objectives.</p><p><strong>Methods: </strong>This was a qualitative process evaluation, from January to September 2023, of two nurse-led HVIPs implemented in a major trauma centre and a large urban hospital in the UK. Interview participants (N=49) were involved with the commission and implementation of the HVIPs, or worked within the broader violence-prevention ecology. We gathered perspectives on intervention implementation and undertook documentary analysis on local and national policies, and guidance relating to HVIPs development, implementation and delivery (N=46). Documentary data were subject to thematic and content analyses, interview data to thematic analysis.</p><p><strong>Results: </strong>HVIPs were developed in response to a perceived under-provision of services for patients attending EDs due to violence. The HVIP nurses had access to clinical records facilitating the identification of eligible patients. They provided patient-centred care, addressing needs through referrals into health and community-based services. Over 60% of eligible patients engaged. The nurses were seen as credible champions working towards a minimally burdensome service that supported and trained ED staff. Embedding HVIPs into usual care took time and was limited by the perceived short-term nature of the intervention.</p><p><strong>Conclusion: </strong>The implementation of nurse-led HVIPs enables access to clinical records, facilitating patient engagement, and can provide an additional service aligned to usual emergency care, supporting both patients and ED staff.</p><p><strong>Pre-registration: </strong>The protocol was pre-registered (ISRCTN 15286575; March 13, 2023) and published before data collection was complete.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"536-541"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/emermed-2025-215161","DOIUrl":"10.1136/emermed-2025-215161","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"e2"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When fast gets dangerous.","authors":"Andre Briosa E Gala, Arthur Yue, Eunice Onwordi","doi":"10.1136/emermed-2024-214806","DOIUrl":"https://doi.org/10.1136/emermed-2024-214806","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 8","pages":"549-562"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden-onset diplopia in an 83-year-old man.","authors":"Ken Yamada, Hirofumi Yamashita","doi":"10.1136/emermed-2024-214506","DOIUrl":"https://doi.org/10.1136/emermed-2024-214506","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":"42 8","pages":"495-533"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary embolism diagnosis and the D-dilemma.","authors":"Daniel Horner, Lara N Roberts","doi":"10.1136/emermed-2025-215058","DOIUrl":"10.1136/emermed-2025-215058","url":null,"abstract":"","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"560-561"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical probability-adjusted (CPA) D-dimer thresholds for the exclusion of venous thromboembolism (VTE) in the emergency department.","authors":"Erin Devlin, Daniel Horner","doi":"10.1136/emermed-2025-215028","DOIUrl":"10.1136/emermed-2025-215028","url":null,"abstract":"<p><p>A short review of the literature was carried out to examine the evidence supporting the use of clinical probability-adjusted (CPA) D-dimer thresholds to exclude venous thromboembolic (VTE) disease in an ED setting. Five papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that using CPA D-dimer thresholds to exclude VTE without recourse to imaging will improve the efficiency of the test, but may increase the failure rate to unacceptable levels. CPA thresholds should be used with caution on an individual basis, supported by shared decision-making.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"550-552"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic analysis of approaches used in cardiac arrest trials to inform relatives about trial enrolment of non-surviving patients.","authors":"Helen Pocock, Abigail Dove, Laura Pointeer, Keith Couper, Gavin D Perkins","doi":"10.1136/emermed-2023-213648","DOIUrl":"10.1136/emermed-2023-213648","url":null,"abstract":"<p><strong>Background: </strong>The recruitment of patients to emergency research studies without the requirement for prior informed consent has furthered the conduct of randomised studies in cardiac arrest. Frameworks enabling this vary around the world depending on local legal or ethical requirements. When an enrolled patient does not survive, researchers may take one of three approaches to inform relatives of their enrolment: a direct (active) approach, providing information indirectly (passively) and inviting relatives to seek further information if they choose, or providing no information about the trial (no attempt). Previous studies have described experiences of US researchers' active approach but there is little known about approaches elsewhere.We aimed to conduct a structured investigation of methods used in cardiac arrest trials to provide information about trial enrolment to relatives of non-surviving patients.</p><p><strong>Methods: </strong>We systematically searched trial registries to identify randomised clinical trials that recruited cardiac arrest patients. Trials were eligible for inclusion if they recruited adults during cardiac arrest (or within 1 hour of return of spontaneous circulation) between 2010 and 2022 (in the decade prior to study conception). We extracted data from trial registries and, where relevant, published papers and protocols. Investigators were contacted and asked to describe the style, rationale and timing of approach to relatives of non-surviving patients. We present descriptive statistics.</p><p><strong>Results: </strong>Our trial registry search identified 710 unique trials, of which 108 were eligible for inclusion. We obtained information from investigators for 64 (62%) trials. Approximately equal numbers of trials attempted to actively inform relatives of non-survivors (n=28 (44% (95% CI; 31% to 57%))), or made no attempt (n=25 (39% (95% CI; 27% to 52%))). The remaining studies provided general information about the trial to relatives but did not actively inform them (n=11 (17% (95% CI; 8% to 29%))).</p><p><strong>Conclusions: </strong>There is wide variability in the approach taken to informing relatives of non-surviving patients enrolled in cardiac arrest randomised clinical trials.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"488-495"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of tongue coating in identifying acute appendicitis: a prospective cohort study.","authors":"Hideki Mori, Kazumi Yamasaki, Yusuke Saishoji, Yuichi Torisu, Takahiro Mori, Yuki Nagai, Yasumori Izumi","doi":"10.1136/emermed-2024-214210","DOIUrl":"10.1136/emermed-2024-214210","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis requires timely diagnosis. The diagnostic efficacy of tongue examination in making this diagnosis has not been established. This study investigates whether the Tongue Coating Index (TCI), a validated measure of tongue coating, can aid in diagnosing acute appendicitis.</p><p><strong>Methods: </strong>We conducted a prospective cohort study (1 September 2018-31 December 2020) at a single Japanese hospital. Adults (≥20 years) with suspected acute appendicitis, presenting to either the emergency department or general outpatient clinic, were enrolled. Tongue images were taken at presentation; two independent examiners-unrelated to clinical care and blinded to patient data-later scored these images using the TCI. A composite reference standard (clinical findings, imaging, histopathology, follow-up) was used to confirm appendicitis. We compared the TCI's diagnostic performance with the Alvarado score and its components using C-index, area under the curve (AUC), sensitivity and specificity.</p><p><strong>Results: </strong>Of 145 included patients, 69 (47.6%) were diagnosed with acute appendicitis. The TCI demonstrated comparable discriminative ability (C-index AUC 0.62; 95% CI, 0.53 to 0.71) to that of the Alvarado score (0.66; 95% CI, 0.57 to 0.75). Of Alvarado score components, migration of pain had an AUC of 0.63 (95% CI, 0.55 to 0.71), anorexia 0.58 (95% CI, 0.50 to 0.66) and tenderness in the right lower quadrant 0.55 (95% CI, 0.50 to 0.60). At a cut-off of 3, the TCI demonstrated high sensitivity of 96% (95% CI, 88% to 98%) but low specificity of 21% (95% CI, 13% to 32%). Conversely, at a cut-off of 10, the TCI showed increased specificity of 83% (95% CI, 73% to 90%) but reduced sensitivity of 29% (95% CI, 20% to 41%).</p><p><strong>Conclusion: </strong>The TCI showed comparable diagnostic performance to the Alvarado score and its individual components. TCI may potentially serve as an additional non-invasive indicator for diagnosing or ruling out acute appendicitis. Further research is essential to validate its clinical utility.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"519-525"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of low-value diagnostic tests in emergency medicine practice: a qualitative descriptive study.","authors":"Vinay Gangathimmaiah, Rebecca Evans, Nishila Moodley, Tarun Sen Gupta, Karen Carlisle","doi":"10.1136/emermed-2024-214241","DOIUrl":"10.1136/emermed-2024-214241","url":null,"abstract":"<p><strong>Introduction: </strong>Low-value diagnostic tests harm patients and healthcare systems. Elucidation of determinants of low-value tests is essential for their de-implementation. The aim of this study was to understand the drivers of low-value tests in emergency medicine (EM) practice.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted at an Australian academic ED. Purposive sampling was used to recruit participants. Semistructured interviews were used to collect data between February 2023 and May 2023. Interviews were audio-recorded, transcribed verbatim and uploaded to NVivo. Data were thematically analysed through line-by-line and axial coding. Codes were assigned to categories, subthemes and themes. Themes were further analysed using the behavioural domains of the Theoretical Domains Framework. Trustworthiness was ensured through reflexivity, data triangulation, thick description, audit trail and member checking.</p><p><strong>Results: </strong>Twenty-four interviews were conducted with participants who had a breadth of EM experience: 19 senior EM doctors and 5 doctors in EM training. Low-value tests were inherently understood and unanimously acknowledged by participants. Six drivers of low-value tests emerged: efficiency, culture, resources, complexity, consequences and abilities. Drivers exerted influence at systemic and individual levels by hindering (barriers) or facilitating (enablers) de-implementation of low-value tests. Drivers mapped to the following behavioural domains of the Theoretical Domains Framework: environmental resources and context (resources, complexity, efficiency), social influences (culture), belief about consequences (consequences), and beliefs about capabilities (abilities).</p><p><strong>Conclusion: </strong>An interconnected web of systemic and individual drivers is influencing emergency doctors' behaviour to perform low-value tests. De-implementation of low-value tests will require behavioural change through contemporaneous navigation of multilevel drivers. Behavioural change theories like the Theoretical Domains Framework provide a robust framework to navigate change in collaboration with multidisciplinary clinicians and community. Evidence-based, theory-informed, co-designed interventions are needed to address the drivers of low-value tests.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"503-510"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of advanced age and aetiology of cardiac arrest with outcomes in patients with out-of-hospital cardiac arrest receiving extracorporeal cardiopulmonary resuscitation: a secondary analysis of multicentre registry study in Japan.","authors":"Yuzuru Mochida, Tomoya Okazaki, Mitsuaki Kojima, Tomohisa Shoko, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda","doi":"10.1136/emermed-2023-213510","DOIUrl":"10.1136/emermed-2023-213510","url":null,"abstract":"<p><strong>Background: </strong>Data on extracorporeal cardiopulmonary resuscitation (ECPR) in older patients, particularly those aged ≥75 years, remain limited and inconsistent. In this study, we investigated the association between advanced age and outcomes in patients receiving ECPR and determined differences in outcomes by aetiology of out-of-hospital cardiac arrest (OHCA) to identify older patients who may benefit from ECPR.</p><p><strong>Methods: </strong>This secondary analysis of a retrospective multicentre cohort study in Japan included adult patients with OHCA who received ECPR between 2013 and 2018. The study outcomes were unfavourable neurological outcomes at discharge, in-hospital mortality and ECPR-related complications. The study cohort was categorised by age groups, and the association between age group and outcomes was investigated. We also compared patient characteristics between favourable and unfavourable outcome groups and performed subgroup analysis to gain insights regarding the group of older patients who could benefit from ECPR.</p><p><strong>Results: </strong>Of the 1904 included patients, 1106 were aged <65 years, 547 were 65-74 years, and 251 were ≥75 years. Patients aged 65-74 years and those aged <65 years had comparable rates of unfavourable neurological outcomes and in-hospital mortality. However, patients aged ≥75 years had significantly higher rates of unfavourable neurological outcomes and in-hospital mortality than those aged <65 years. Subgroup analysis of crude mortality rates revealed relatively high survival rates for patients with pulmonary embolism (54.5%) or hypothermia (25%) compared to those with other causes of arrest in the ≥75 years group.</p><p><strong>Conclusions: </strong>Patients with OHCA aged ≥75 years and receiving ECPR are at higher risk of unfavourable neurological outcomes and in-hospital mortality than those aged <65 years. However, neurological outcomes and in-hospital mortality in patients aged ≥75 years vary with the causes of OHCA. ECPR outcomes in super-geriatric patients with OHCA may be comparable to those in younger patients for specific aetiologies.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"526-533"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}